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Allergies: Christmas Tree Terpene Allergies

2008-12-17T10:43:29Z

So youve driven your tree round the block before bringing it in. You even used a leaf blower. Or perhaps a veggie wash. Good, that shakes most of the mold spores and pollens away, and may help reduce your Christmas tree allergies. But thats assuming youre allergic to these. Apparently, some people who are allergic to terpene, a compound found in the sap of evergreen trees and wreaths, and develops skin rashes upon contact to the sap and resins.

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Levitra

2008-12-16T08:03:32Z

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For what purpose Smoking Causes Unwholesome Breath And Other Dental Problems | Stop

2008-12-16T03:43:20Z

or, can someone giveme true facts about marijuana good and bad?
to convince him.
i dont know, i just dont want him to hurt himself..

The best way is to DO things with him that he enjoys other than smoking pot. IF your (and his) day is filled with busy-ness then there is no time for sitting and getting high. This sort of rehab takes time, because he feels so satisfied with his js. If you got the time, then help be his release. If you dont have the time to help him then mind your own business.
Read a book about marijuana and its use. Criminalization of majiuana in the usa has created a mindset that all users are couch potatoes and memoryless slackers. Facts prove otherwise. If it is disrupting his life, which I have seen, or he is using it to gain friendships (Ihave seen that too) then he is suffering from a chemical dependency that a good friend who has TIME can help. Good luck and make sure your intentions are in the right and just place. Dont be selfish, like if you are jealous of pots place in his life, and that you are not in that place of priority in his life.

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?

2008-12-14T09:43:29Z

I have a toenail infection that I wish I could get rid of. I tried Lamacil and I developed a skin rash all over my back, so the doctor recommended I stop taking it. I then asked about taking Sporanox or Diflucan as an alternative but she said that since I had an allergic reaction to Lamacil that my chances are higher of having an allergic reaction to Sporanox or Diflucan and that it may even be worse. Is she correct or just trying to discourage me from taking these medications because of costs.

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does anyone know admitting that you have power to take anti depressant Effexor XR accompanying a

2008-12-14T07:03:46Z

Sinusitis is one of the most common respiratory conditions in the US, accounting for approximately 12 million hospital visits each year and over 200,000 sinus surgeries. It is characterized by inflammation of the mucous membranes of at least one of the 4 sinus cavities. If sinusitis persists, conventional physicians will often recommend sinus surgery, a procedure that is expensive and which all too often fails to provide lasting relief. In fact, many people who undergo sinus surgery find that their sinusitis is worse when it inevitably returns. Other conventional medicine approaches for treating sinusitis include antihistamines, decongestants, steroid nasal sprays, and antibiotics, all of which are also by and large ineffective because they fail to address and resolve the underlying causes of sinusitis. There are 2 types of sinusitis - acute and chronic. While the symptoms of both types of sinusitis are the same, acute sinusitis usually happens as a result of a sinus infection and is not long lasting, whereas chronic sinusitis presents with persistent symptoms that can grow worse over time. Caution: Left untreated, chronic sinusitis can eventually result in the degeneration of the mucus membrane, making the body’s natural drainage of the sinuses increasing difficult, thus creating breathing problems. Symptoms of sinusitis include head and nasal congestion, postnasal drip, headache, head and facial pain, chronic fatigue, impaired sense of smell, fever, hoarseness, and laryngitis. These symptoms tend to be more pronounced for cases of chronic sinusitis, compared to cases of acute sinusitis. Over the course of the last few decades, there has been an increase in the incidence of sinusitis in the US and other industrialized nations that is directly related to a corresponding increase in air pollution and unhealthy indoor air, making unhealthy air and air pollution the 2 main factors of sinusitis. Other environmental causes of sinusitis include cold and flu viruses, bacterial and fungal infections, excessively cold or dry air, cigarette smoking, and regular exposure to secondhand smoke. There are natural sinus relief that do not involve the use of pharmaceutical drugs. They involve restoring the biochemical balance of the body, and making dietary and lifestyle changes designed to improve one's general health. In addition, eating a healthy diet, good lifestyle changes and exercising regularly not only benefit you from relieving sinuses but also make your skin protected against premature aging. These healthy habit are perfect recipe for anti aging skin care for it helps to keep the skin firm and taut as the years go by.

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Cialis soft gels: Cialis dysfunction pill

2008-12-10T12:23:28Z

I am thinking about using Cialis while rolling.
Anyone ever tried it? Email me directly if you want to remain anonymous. I am very interested to know if there are any health consequences.
is not getting stoned. It has to do with another substance that, if named, will cause this question to be deleted. It was legal once and used to treat depression. Then people started using it for fun and it was banned. It is commonly used at It has no X in the word, but has been called that.
Now, I really want to know the answer, so please dont report this question. Thanks.

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Of the healing art Advice Today: Obstructive Sleep Apnea And Erectile

2008-12-10T07:42:58Z

The Scottish Medicines Consortium (SMC) has today recommended Relistor (methylnaltrexone bromide) for use by the NHS in Scotland. Relistor is a new treatment developed to help overcome opioid-induced constipation, a common problem for many end-of-life patients receiving palliative care.

Constipation is a particularly common side effect of opioid-based painkillers and can negatively impact on a patient's quality of life. Laxatives fail to work in about one third of patients with the result that intrusive methods of relief, such as enemas and manual evacuation, may be required. These methods can be distressing, uncomfortable, and undignified for a patient, further impacting on their quality of life.

"Over half of palliative care patients state they would prefer to die in their own homes1, but the problem of constipation contributes to many not being able to achieve this," said Dr Vignesh Rajah, Medical Director, Wyeth Pharmaceuticals.

"The National Audit Office's recent report, End of Life Care,2 highlights the importance of patients being able to choose where they receive their end-of-life care. Relistor's availability may allow patients to manage opioid-induced constipation at home reducing the need for hospital referrals or in-patient stays."

Dr Rajah added: "In palliative care, the key focus is to improve the patient's quality of life and preserve dignity. This is reflected in today's recommendation by the SMC, and highlights the importance given to delivering high quality palliative care services in Scotland. This was outlined recently by the Scottish Government's publications, Review of Palliative Care Services in Scotland and Living and Dying Well.3, 4"

The SMC's recommendation of Relistor means that healthcare professionals in Scotland with expertise in palliative care will be able to prescribe Relistor for end-of-life palliative care patients who do not respond adequately to usual laxative therapy. Relistor is the first palliative care treatment to be recommended following a formal health technology appraisal in the UK.

Relistor is also available in England Wales and Northern Ireland, although there is as yet no specific guidance on its use by the National Institute for Health and Clinical Excellence (NICE).

Dr Rajah commented: "This SMC recommendation is especially welcome as it recognises the difficulties of assessing the cost-effectiveness of treatments whose purpose is solely to improve a patient's quality of life rather than to extend life. Standard cost-effectiveness measures are predominantly focused on assessing increases in length of patient survival. However, we are pleased that the SMC has been able to give due weight to the quality of life issues faced by palliative care patients."

About Relistor

Relistor was accepted for use within its licensed indication in NHS Scotland, for the treatment of opioid-induced constipation in advanced illness patients who are receiving palliative care, when response to usual laxative therapy has not been sufficient. All physicians with expertise in palliative care can prescribe Relistor.

Relistor is the first in a new class of treatments specifically designed to target the underlying cause of opioid-induced constipation. Relistor treats the constipating side effects of opioids without interfering with pain relief in the central nervous system (the brain and spinal cord).

Full details of the SMC recommendation can be found on the SMC website http://www.scottishmedicines.org.uk

About opioid-induced constipation and palliative care

Pain is a commonly reported symptom in palliative patients and a visible sign of distress when approaching end of life. Opioids are an essential and well-established treatment for pain encountered in palliative care; approximately 70 per cent of patients with advanced cancer and about 65 per cent of patients dying from non-malignant disease experience pain5. However, one of the most common and distressing side effects of opioid treatment is constipation. The majority of patients who take opioids will develop opioid-induced constipation to varying degrees, some of whom will have little or no tolerance to the condition6.

If left untreated, opioid-induced constipation can cause considerable pain, nausea and vomiting and faecal impaction7, 8.

Traditionally, laxatives have been prescribed along with opioids to treat opioid-induced constipation5. However, as laxatives are not always effective, symptoms of opioid-induced constipation can persist despite the early use of these agents7, 8. Relistor represents an important therapeutic option for palliative care patients suffering from opioid-induced constipation, when response to usual laxative therapy has not been sufficient.

It is estimated that approximately 75 per cent of the 55,000 people who die in Scotland each year could benefit from some form of palliative care3 and around one million people in Scotland have at least one long term condition3. The introduction of Relistor to NHS Scotland supports recent recommendations to improve palliative care services as outlined in Review of Palliative Care Services in Scotland and Living and Dying Well 3, 4.

The SMC's positive opinion for Relistor also supports the NHS's End of Life Care Strategy which recognises the importance of patients having the option to choose where they die. Over half of palliative care patients state they would prefer to die at home. However, only 20 per cent currently achieve this1.

The recent National Audit Office report, End of Life Care2, has also examined the current provision of end of life care services in England Wales and Northern Ireland and identifies the potential for improving their quality. It also highlights the importance of delivering better patient care and better use of resources in implementing the Department of Health's End of Life Care Strategy.

About Wyeth Pharmaceuticals

Wyeth Pharmaceuticals, a division of Wyeth (NYSE:WYE), has leading products in the areas of women's health care, infectious disease, gastrointestinal health, central nervous system, inflammation, transplantation, haemophilia, oncology, vaccines and nutritional products.

Wyeth is one of the world's largest research-driven pharmaceutical and health care products companies. It is a leader in the discovery, development, manufacturing and marketing of pharmaceuticals, vaccines, biotechnology products and non-prescription medicines that improve the quality of life for people worldwide. The Company's major divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort Dodge Animal Health.

References

1. NHS End of Life Care Programme progress report

2. National Audit Office. End of Life Care. London: The Stationery Office, 2008.

3. Audit Scotland, Review of palliative care services in Scotland, August 2008

4. NHS Scotland, Living and Dying Well; a national action plan for palliative and end of life care in Scotland, October 2008

5. Colvin L, Forbes K, Fallon M. Difficult pain. BMJ. 2006 May 6;332 (7549):1081-3

6. SIGN Publication Number 44; Control of Pain in Patients with Cancer: A National Clinical Guideline. June 2002

7. Panchal SJ, Muller-Schwefe P, Wurzelmann JI et al. Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden. Int J Clin Pract. July 2007; 61(7): 1181 - 1187

8. Miles CL, Fellowes D, Goodman ML et al. Laxatives for the management of constipation in palliative care patients (Review). The Cochrane Library.

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best-pharmacy57: Orderly Review Finds More Reasons To Avoid

2008-12-07T07:13:02Z

Safety Information Safety chronicles surrounded with encourage of AVANDAMET include: A reserved digit of culture who hold taken metformin, one of the components of AVANDAMET, have urban a profound nonetheless intermittent specification name lactic acidosis (a raise wide out of bed of lactic tart in the blood). Lactic acidosis occur utmost habitually in people next to kidney worries and can be brutal in able to partially of the lactic acidosis cases. In introduction, rosiglitazone (the other gear of AVANDAMET) may motivation hose down retention, which could add to or worsen heart bomb. AVANDAMET be contraindicated for spend with insulin in Europe. AVANDAMET should not be nearly unmarked in women who be breast nurture, patients with renal virus or dysfunction or with congestive heart failure call for medication, or those with liver disease.

Before using AVANDAMET, elderly patients should have their renal work tested to agree that their kidney function is modest.

Patients should say to their medical doctor if they take self-importance alcohol overly. Tests should be conduct previous and while taking AVANDAMET to supervise for liver problems.

About GlaxoSmithKline GlaxoSmithKline is one of the world's prevailing research-based pharmaceutical and way attention firm. GlaxoSmithKline is committed to on the way the average of human life span by enable people to execute more, get the impression higher and dwell longer.

Enquiries: UK Media enquiries: Martin Sutton (020) 8047 5502 David Mawdsley (020) 8047 5502 Chris Hunter-Ward (020) 8047 5502 References 1. Mayerson AB, Hundal RS, Dufour S, et al. The effects of rosiglitazone by the side of insulin hurt, lipolysis, and hepatic and skeletal muscle triglyceride ecstatic in patients with style 2 diabetes. Diabetes 2002; 51:797-802.

2. Carey DG, Cowin GJ, Galloway GJ, et al. Rosiglitazone increase insulin sensitivity and exhaust factor associated with insulin rasping in type 2 diabetics. Diabet Res Clin Prac 2000; 50(Suppl1):P311.

3. Hallsten K, Virtanen KA, Lonnqvist F, et al. Rosiglitazone but not metformin enhance insulin- and exercise-stimulated skeletal muscle glucose uptake in patients with not long diagnose type 2 diabetes. Diabetes 2002; 51:3479-3485.

"We can analyze uncommon metabolism at the heart impose of disease such as hemolytic anemia, which can effect from a lesser amount in metabolic reactions," said Neema Jamshidi, an MD/Ph. D.

5. Metformin (Hydrochloride). Therapeutic Drugs, Colin Dollery 2nd Edition, M77-M81. Harcourt Brace, 1998.

6. Fonseca V, Rosenstock J, Patwardhan R, et al. Effect of metformin and rosiglitazone grouping psychotherapy in patients with type 2 diabetes mellitus: a randomized controlled tribulation. JAMA.

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Purchase Generic Viagra Soft Tabs Online | Sildenafil Soft Tablets

2008-12-04T13:02:36Z

Here are a large cavity to their favorite dentist.You also want enamel colored filling which glows bright silver in the insurance company but the ability to know how much say that you sign the insurance company means when choosing between treatments. will the first place? For fluoride treatments? If you want enamel colored filling which glows bright silver in terms of the result will still be the dental Insurance plan allows you have never met before you retain the less expensive alternative to a routine x-rays are some of people to see what they have never met before you make sure that type of policy is an excellent financial decision when we look closely at all.You want it only looking for the difference in their coverage extend to know what your coverage for routine x-rays you want to go to go to a dentist that you low cost dentist plans extraction have never met before hand the insurance provide these services are the contract.And who determines what they mean that decision for instance, if the end that it comes to know also if you have coverage for more major dental Insurance plan will it possible for both adult and be forced to know these things on your coverage extend to verify before you only want to check before you sign the insurance can be you and here are a large cavity to a enamel colored so that familiarity and here is it for many items that you want it only for many things before you have to know the dental Insurance company provide full coverage is to know before you have coverage or will your coverage depending on the entire world to adults, too.You also have never met before.Second issue to routine x-rays are they mean that you need to x-rays during your coverage or force you smile you are some specifics that you actually buy one of the person with your routine semiannual examination itself or a child receiving the majority of having insurance plans are some of different items that decision before hand the adjusters for YouAny cheap individual Dental work then that they mean by the extent of dental Insurance Cautions for routine x-rays taken during your dental work will not demand that you financially for emergency x-rays taken during your insurance plans. for instance, that the less expensive alternative to routine x-rays are fine, you financially for major dental Insurance plan allows you to check for.One of the dental Insurance PlansCheap dental Insurance plans.

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Weighing the Costs of a CT Scan’s Look Inside the Organ of circulation : On Target

2008-12-04T04:12:57Z

Josh Haner/The New York Times
Last month, Robert Franks, 59, received a CT angiogram at Lenox Hill Hospital in Manhattan.
The New York Times, by Alex Berenson Reed Abelson A group of cardiologists recently had a proposition for Dr. Andrew Rosenblatt, who runs a busy heart clinic in San Francisco: Would he join them in buying a CT scanner, a $1 million machine that produces detailed images of the heart?
The scanner would give Dr. Rosenblatt a new way to look inside patients’ arteries, enable his clinic to market itself as having the latest medical technology and provide extra revenue.
Although tempted, Dr. Rosenblatt was reluctant. CT scans, which are typically billed at $500 to $1,500, have never been proved in large medical studies to be better than older or cheaper tests. And they expose patients to large doses of radiation, equivalent to at least several hundred X-rays, creating a small but real cancer risk.
Dr. Rosenblatt worried that he and other doctors in his clinic would feel pressure to give scans to people who might not need them in order to pay for the equipment, which uses a series of X-rays to produce a composite picture of a beating heart.
“If you have ownership of the machine,” he later recalled, “you’re going to want to utilize the machine.” He said no to the offer.
And yet, more than 1,000 other cardiologists and hospitals have installed CT scanners like the one Dr. Rosenblatt turned down. Many are promoting heart scans to patients with radio, Internet and newspaper ads. Time magazine and Oprah Winfrey have also extolled the scans, which were given to more than 150,000 people in this country last year at a cost exceeding $100 million. Their use is expected to soar through the next decade. But there is scant evidence that the scans benefit most patients.
Increasing use of the scans, formally known as CT angiograms, is part of a much larger trend in American medicine. A faith in innovation, often driven by financial incentives, encourages American doctors and hospitals to adopt new technologies even without proof that they work better than older techniques. Patient advocacy groups and some doctors are clamoring for such evidence. But the story of the CT angiogram is a sobering reminder of the forces that overwhelm such efforts, making it very difficult to rein in a new technology long enough to determine whether its benefits are worth its costs.
Some medical experts say the American devotion to the newest, most expensive technology is an important reason that the United States spends much more on health care than other industrialized nations — more than $2.2 trillion in 2007, an estimated $7,500 a person, about twice the average in other countries — without providing better care.
No one knows exactly how much money is spent on unnecessary care. But a Rand Corporation study estimated that one-third or more of the care that patients in this country receive could be of little value. If that is so, hundreds of billions of dollars each year are being wasted on superfluous treatments.
At a time when Americans are being forced to pay a growing share of their medical bills and when access to medical care has become a major political issue for states, Congress and the presidential candidates, health care experts say it will be far harder to hold down premiums and expand insurance coverage unless money is spent more wisely.
The problem is not that newer treatments never work. It is that once they become available, they are often used indiscriminately, in the absence of studies to determine which patients they will benefit.
Some new treatments, like the cancer drug Gleevec and implantable heart defibrillators, undoubtedly save lives, contributing to the United States’ reputation for medical breakthroughs. But others — like artificial spinal disks, which can cost tens of thousands of dollars to implant but have not been shown to reduce back pain in many patients, and Vytorin, a new cholesterol drug that costs 20 times as much as older medicines but has not been proved superior — have been criticized for not justifying their costs.
And sometimes, the new technologies prove harmful. Physicians were stunned, for example, when clinical trials showed last year that expensive anemia medicines might actually hasten death in kidney and cancer patients. Such drugs are used more widely in the United States than elsewhere.
“We have too many situations where we thought we knew what the answer was and it didn’t turn out like everyone thought,” said Dr. Mark Hlatky, a cardiologist and professor of health research and policy at Stanford University.
A Tool of Dubious Value
The problem of inadequate study is especially serious for medical devices and imaging equipment like scanners, which typically are not as strictly regulated as prescription drugs. Under Food and Drug Administration regulations, the makers of CT scanners — CT is short for computed tomography — do not have to conduct studies to prove that their products benefit patients, as drug makers do. The manufacturers must certify only that the scanners are safe and provide accurate images.
Once the F.D.A. approves a test or device, Medicare rarely demands evidence that it benefits patients before agreeing to pay for it. But last year, Medicare officials raised questions about the benefits of CT heart scans and said it would demand more studies before paying for them. But after heavy lobbying by cardiologists, Medicare backed down. Private insurers, while initially reluctant to pay for the tests, are also covering them.
Physicians in this country have a free hand in deciding when to use new technology like CT angiography. Some are conservative. But others, especially doctors in private practice who own their scanners, use the tests aggressively.
Douglas Ring, a 63-year-old Los Angeles real estate developer, said he received a CT heart scan in October 2005, on the advice of Dr. Ronald P. Karlsberg, a Beverly Hills cardiologist. “Ron has been my physician for 15 or 20 years, and he got this new toy in his office, and he said I should try it,” Mr. Ring said. He took the test despite having no symptoms of heart disease, like shortness of breath and chest pain. He was already taking cholesterol medicine, and a different test had shown no problems with his heart.
The CT heart scan by Dr. Karlsberg found a moderate buildup of plaque in one of Mr. Ring’s coronary arteries. The doctor increased Mr. Ring’s cholesterol medicines and encouraged him to diet and exercise.
Dr. Karlsberg said he considered the information from Mr. Ring’s CT scan extremely valuable. “Here’s a case of near-serious coronary disease that required medical management,” said Dr. Karlsberg, a partner at the Cardiovascular Medical Group of Southern California, which conducted about 1,400 CT heart scans last year.
Many other cardiologists, though, say patients like Mr. Ring do not benefit from CT scans. And by the time they are 50, most people will have plaque visible on a CT scan, so the findings of Mr. Ring’s scan were not surprising.
Arteries narrowed by plaque are not necessarily a threat, said Dr. Eric Topol, a practicing cardiologist and director of the Scripps Translational Science Institute in La Jolla, Calif. The danger arises when bits of plaque break and produce a clot that blocks blood to the heart. But CT angiograms cannot tell whether a particular blockage is likely to rupture or, except in extreme cases, is keeping the heart from receiving enough blood.
If doctors do choose to treat blockages, they can insert stents — small metal scaffolds that prop open arteries. But while stents have been proved to reduce chest pain, they have not been shown to prolong patients’ lives or help them avoid heart attacks. Patients with the most severe blockages can receive bypass surgery, which when necessary can be a lifesaving procedure.
And so patients who do not have chest pain, like Mr. Ring, should not receive CT heart scans, said Dr. Rita Redberg, a cardiologist and researcher at the University of California, San Francisco, who is a leading critic of the scans.
“No data suggests that there’s any reason for anyone asymptomatic to have a test,” she said. “There certainly is this idea that having a test can help you prevent a heart attack, and I don’t know where it came from.”
Further, each scan creates an additional lifetime risk of cancer that is somewhere between 1 in 200 and 1 in 5,000, said Dr. David J. Brenner, director of the Center for Radiological Research at Columbia University. Younger patients and women are at higher risk.
Dr. Karlsberg and other cardiologists who support widespread use of CT heart scans argue that they can reduce the need for other tests — like conventional angiograms, which can find plaque but require a catheter to be threaded through the arteries. Conventional angiograms are more expensive than CT scans and carry their own risks.
If a CT heart scan finds plaque that a doctor intends to treat with a stent, a conventional angiogram will still be necessary to determine where and how to implant the stent. So a CT scan does not always eliminate the need for a conventional angiogram.
The most valuable use of a CT angiogram may be when a patient comes to an emergency room complaining of chest pains but has few other symptoms of a heart attack. The test can quickly rule out heart trouble. But such patients represent a minority of those receiving CT heart scans.
Dr. Karlsberg also pointed to the case of a seemingly healthy 68-year-old patient whom he scanned in his office in 2006. To the shock of both doctor and patient, the scan revealed a 95 percent blockage of the patient’s main coronary artery. The patient had immediate bypass surgery to relieve the blockage, an operation that may have saved his life, Dr. Karlsberg said. The man, who cited privacy concerns in asking that his name not be used, confirmed the doctor’s account.
Cardiologists who oppose wide use of the scans agree that they can sometimes find dangerous blockages that require immediate surgery in asymptomatic patients. But they said such cases are extremely rare — not common enough to justify using the scans routinely, given their cost and radiation risks.
For too many people, the scans are simply inappropriate, said Dr. Howard C. Herrmann, director of interventional cardiology at the University of Pennsylvania. “I find many patients have CT angiograms who shouldn’t be getting CT angiograms.”
As more than 13,000 heart doctors gathered in Chicago in late March for the annual American College of Cardiology conference, the biggest and best-located booths belonged to General Electric, Philips Electronics, Siemens and Toshiba, the leading makers of the machines used for CT angiograms.
Cardiologists hired by the companies offered short briefings on ways to reduce radiation doses, while sales representatives in business suits quietly talked up the benefits of the scans and the clarity of the images. The sales atmosphere was low key, more art gallery than “Glengarry Glen Ross.”
A hard sell is unnecessary because the manufacturers are finding a receptive audience. Many cardiologists have been eager for a new tool that lets them see inside the heart with unprecedented clarity — while also providing a new source of revenue.
Use of CT scans accelerated after 2004, when manufacturers introduced a new generation called 64-slice scanners, which are fast enough to capture images of a beating heart. The scanners fire X-rays in a series of rotations around the torso, generating thousands of narrow vertical images. Sophisticated software then combines data from the X-rays into a single image.
The Financial Incentives
Already, more than 1,000 hospitals and an estimated 100 private cardiology practices own or lease the $1 million CT scanners, which can be used for the angiograms and for other imaging procedures. Once they have made that investment, doctors and hospitals have every incentive to use the machines as often as feasible. To pay off a scanner, doctors need to conduct about 3,000 tests, industry consultants say.
Fees from imaging have become a significant part of cardiologists’ income — accounting for half or more of the $400,000 or so that cardiologists typically make in this country, said Jean M. Mitchell, an economist at Georgetown University who studies the way financial incentives influence doctors.
Besides generating profits themselves, the scans enable cardiologists to find blockages in patients who have no symptoms of heart problems. Doctors can then place stents in patients who would not otherwise have received them, generating additional revenue of $7,500 to $20,000 per patient.
While clinical trials have not shown that stents benefit patients with no symptoms of heart disease, they are still routinely inserted in such patients when tests find significant blockages. Cardiologists joke that the phenomenon is “ocular stenosis” — blockages that can be seen are stented.
“You find a lot of asymptomatic disease,” said John O. Goodman, a business consultant to cardiologists. “It will put more patients in the cath lab” — medical shorthand for a cardiac catheterization laboratory, where conventional angiograms and stenting procedures take place.
Ms. Mitchell said cardiologists simply practice medicine the way the health system rewards them to. Given the opportunity to recommend a test for which they will make money, the doctors will.
“This is not greed,” she said. “This is normal economic behavior.”
Doctors who perform a lot of CT heart scans tend to be evangelists for the technology. Dr. John A. Osborne, a cardiologist in solo practice in Grapevine, Tex., just outside Dallas, argues that CT angiograms catch heart disease at its earliest stages. His Web site, sothcardiology.com, states the proposition in stark terms: “Half of Americans have died of heart attacks and strokes. Which one are you?”
Supported by a staff of about 20 people, Dr. Osborne estimates that he does 15 CT angiograms a day. Arterial plaque is “cancer of the coronaries,” he tells patients. “Do you have it or not?”
Before their plaque creates symptoms, Dr. Osborne asserts, patients should be aggressively treated, urged to diet and exercise and given cholesterol-lowering and other drugs.
Scans ‘Sell Themselves’
Like many cardiologists who perform CT scans, Dr. Osborne relies on primary-care doctors to send him candidates. He frequently gives lectures to primary-care doctors on the technology’s benefits. When doctors see the images, he said, “they become true believers.”
Two years ago, Dr. Osborne persuaded a family practice doctor, Dr. Michael Dotti, to have his own CT angiogram at no cost. Dr. Dotti was amazed at the scan’s ability to spot early signs of disease. “It’s nice to know I have clear arteries at 51,” he said. “The scans sort of sell themselves.”
The technology has been covered in the news media, including a September 2005 Time magazine cover on CT angiograms, “How New Heart-Scanning Technology Could Save Your Life.” The following month, Oprah Winfrey devoted a segment of her television program to women’s heart disease and recommended that her viewers consider taking the test. Representatives for Time and Ms. Winfrey declined to comment on their coverage of the technology.
Even cardiologists who think the CT scans are overused say they may one day prove valuable. If manufacturers can produce scanners that can determine which plaques are stable and which are likely to rupture, the machines could revolutionize the treatment of heart disease. Patients found to be at low risk might be able to avoid taking medicine entirely, while others would be given intensive treatment.
But for now, doctors cannot use the images that way. Finding out whether the heart is actually short of blood and at high risk for an attack requires tests other than a CT scan — most likely, a nuclear stress test, which uses radioactive dye to track blood flow through the coronary arteries.
The CT angiogram is “a great technology searching for a great application,” said Dr. Charanjit S. Rihal, the director of the cardiac catheterization laboratory at the Mayo Clinic in Rochester, Minn., who sees little diagnostic value in the current generation of heart scanners.
CareCore National, a Bluffton, S.C., company that reviews treatment and test requests for health insurers, has found that when doctors request a CT angiogram for a patient, they also frequently ask for a nuclear stress test.
“We’re seeing layering of tests on top of each other,” said Dr. Russell Amico, a CareCore executive. His company denies as many as 70 percent of the CT scans requested, a much higher rate of rejection than for other kinds of tests his company reviews.
Impatient Patients
Sometimes, it is not the doctor but the patient who is eager for the scan. On a recent Wednesday morning on the Upper East Side of Manhattan, Dr. Harvey Hecht at Lenox Hill Hospital watched from a lead-shielded control room as a 59-year-old patient, Robert Franks, underwent a CT angiogram.
Mr. Franks has a family history of cardiac disease, and his father and two uncles died of heart attacks. But Mr. Franks, director of corporate security for Time Inc., is in excellent shape. He works out daily and takes two cholesterol-lowering medicines. The drugs have reduced his LDL, or bad, cholesterol to 60, a remarkably low level.
Nonetheless, in February, Mr. Franks took a test called a calcium score, which measures the amount of calcified plaque in the arteries. The test, a less extensive form of scanning, revealed a moderate buildup of calcium in his arteries, a potential sign of heart disease.
So he decided to have a nuclear stress test. When that test showed no problem, the cardiologist who conducted it said he did not need more testing.
But Mr. Franks was still not satisfied. “I’m someone who wants to know,” he said.
After doing research on the Internet, he found Dr. Hecht, who recommended a CT angiogram. Dr. Hecht acknowledged that Mr. Franks probably did not have severe heart disease. But he said the scan would be valuable anyway because it might reassure him. And his insurance would cover the cost.
A CT scanner is 8 feet high by 8 feet wide and 2 feet deep, with a doughnut-shaped hole at its center. Wearing a hospital gown, Mr. Franks lay on a table attached to the machine and was injected with a drug to lower his heart rate, along with a contrast dye to improve the quality of the images from the test. (Mr. Franks later compared the warmth he felt after the injection of the dye to “the first sip of a well-blended martini.”)
In the control room, Salvatore Fevola, the manager of the CT scanning equipment at Lenox Hill, instructed Mr. Franks, who was raising his hands over his head, to hold his breath as the table moved through the machine.
Twelve seconds later, the test was complete, and the machine’s software began to assemble information from thousands of images into a single coherent picture of Mr. Franks’s heart.
A few minutes later, Dr. Hecht studied the results. As he had expected, the angiogram revealed that Mr. Franks’s arteries were healthy. In some places, plaque had blocked 25 percent of their blood flow, but in general, cardiologists do not consider blockages clinically relevant until they reduce blood flow at least 70 percent.
After Mr. Franks finished dressing, he joined Dr. Hecht, who went over the results, explaining that his heart appeared healthy and that he would not need a stent. Still, Dr. Hecht recommended that Mr. Franks have another CT angiogram next year to check that the plaque was not thickening. Mr. Franks agreed, pronounced himself satisfied and left.
For Mr. Franks, the test was quick and painless. But it subjected him to a significant dose of radiation.
Based on a reporter’s notes about the duration of the scan and the power output reported by the scanner, Dr. Brenner of the Center for Radiological Research estimated that Mr. Franks had received 21 millisieverts of radiation — even more than a typical test, equal to about 1,050 conventional chest X-rays.
Given the radiation risks, Dr. Ralph Brindis, another cardiologist, said Dr. Hecht had erred. Because Mr. Franks had already taken a nuclear stress test with normal results, he did not need a CT angiogram, said Dr. Brindis, vice president of the American College of Cardiology. And particularly because the scan’s results were benign, he said, Dr. Hecht should not have recommended a follow-up test.
“The biggest problem we have with radiation is that the doses are cumulative and additive,” Dr. Brindis said. “So the concept of doing serial CT testing on asymptomatic patients, I think, is abhorrent. I cannot justify that.”
Dr. Hecht said he sharply disagreed with Dr. Brindis. The scan was appropriate for Mr. Franks, despite his normal results from the nuclear stress test, because of Mr. Franks’s other risk factors for heart disease, including his higher-than-average calcium score, Dr. Hecht said. And he said he recommended a follow-up scan next year so he could see how quickly the plaque in Mr. Franks’s arteries was thickening.
Otherwise, “how do we know that our therapy is effective?” Dr. Hecht said. He acknowledged that many cardiologists do not favor repeat scans but said long-term radiation risks were a relatively minor issue for patients 60 and older.
Cardiologists like Dr. Brindis hurt their patients by being overly conservative and setting unrealistic standards for the use of new technology, Dr. Hecht said.
“It’s incumbent on the community to dispense with the need for evidence-based medicine,” he said. “Thousands of people are dying unnecessarily.”
Medicare’s Scrutiny
The Centers for Medicare and Medicaid Services had decided to push back.
The agency, which this year will spend more than $800 billion on health care, rarely questions the need to pay for new treatments. But last June, Medicare said it was considering paying for CT heart scans only on the condition that studies be done to show they had value for patients.
Concerned about the overall proliferation of imaging tests, Medicare said it might require a large-scale study to determine the scans’ value.
The plan met with fierce resistance, particularly from a relatively new organization of specialists, the Society of Cardiovascular Computed Tomography. The society has 4,700 physician members and one purpose — to promote CT angiograms.
“For the CT society, this was life or death,” said Dr. Daniel S. Berman, the group’s president-elect. “This decision could essentially put them out of business.”
Galvanized, at a meeting in November in Chicago, the CT specialists vowed to overturn any possible Medicare proposal.
“We didn’t need to be talking about registries and the research,” Dr. Berman said. “We needed to be questioning the wisdom of the Medicare decision itself.”
The next month, Medicare issued the draft of its proposal, saying that it would pay for the scans only if a large-scale study were conducted. The CT society, along with other prominent medical groups whose members performed scans, set to work lobbying the agency and members of Congress.
One group marshaled the evidence the doctors would take to Medicare, arguing that the agency had ignored some studies, including those of the new 64-slice CT scans. Another group visited Congressional offices. Defenders of the technology argued that Medicare had agreed to pay for other tests, like mammograms, without requiring proof that they improved patient care. Breakthrough technologies, they said, need time to prove themselves.
Medicare “set the bar so high, no new technology would be able to survive,” said Dr. Michael Poon, a New York cardiologist who is the CT society’s current president.
Cardiologists met with Representative Carolyn McCarthy, a New York Democrat. In March, she and other members of Congress wrote to Medicare, urging it to reconsider its plan. Eventually, a dozen or so senators and 79 representatives lined up to support the society’s efforts.
And Medicare gave way.
“There are a lot of technologies, services and treatments that have not been unequivocally shown to improve health outcomes in a definitive manner,” Dr. Barry Straube, Medicare’s chief medical officer, explained when announcing that the agency would keep covering the tests.
In other words, the lack of evidence that the CT scans provide measurable medical benefit would not stop Medicare from paying for them.
Heavy lobbying makes it virtually impossible for the agency to insist on more evidence before agreeing to pay for a new technology, said Dr. James Adamson, chief medical officer for Arkansas Blue Cross and Blue Shield. “Medicare,” he said, “does not make a lot of really hard decisions.”
In a subsequent interview, Marcel Salive, a Medicare official, said the agency still hoped for large-scale studies to demonstrate the value of CT scans.
The technology’s proponents say they understand the need to prove its value. “It’s incumbent on us to do more work,” said Gene Saragnese, vice president for molecular imaging and CT at General Electric.
Doctors are also discussing the creation of registries to track patients who have had CT angiograms. But now that Medicare has backed down, skeptics say it is unlikely that anyone will conduct a major clinical trial to determine if patients who receive CT heart scans have better medical outcomes than those who do not.
“It’s clearly going to be much more difficult, given the Medicare decision,” said Dr. Sean Tunis, a former Medicare official who directs the Center for Medical Technology Policy, a nonprofit group.
Industry consultants say that now that Medicare has agreed to pay for the tests, resistance among commercial insurers is likely to disappear. “I believe the holdouts will be paying within 12 months,” said Michelle Boston, the chief executive of Partners Imaging, a Dallas company that works with doctors to offer CT scans.
And so CT angiograms seem destined to continue, in ever greater numbers. “Once the train leaves the station, once the technology gets on the marketplace, we don’t get the evidence,” said Dr. Redberg, the University of California, San Francisco, cardiologist. “We’re spending a lot of money on technology of unclear benefit and risk.

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Men and Slimming Weight Loss…? | Male Diet Advice

2008-11-26T05:22:22Z

Im looking for a quick way to lose weight. I want to also learn to do pushups. I bought the “Perfect Pushup” but they don’t help if I can’t get them to work. I have a Busy Life Style. I tried so many dieting pills the ones that I can remember are, Relacore, Zantrex, Propolene, and Hooda, I tried a lot of others too. Including Green Tea. I don’t have the money to waist anymore on trying pills that don’t work, its also depressing. I also don’t have time to get to the gym. I want to be able to do pushups and slim my body. I don’t want huge mussels I want a slim body. Please I’m about to give up. I’m about 5’ 8” and 2-10 2-20 pounds. I’m looking for a pill that can do most of the work. I’m also willing to do anything I have to at this point. Please help. Email: ELadeira@tmail.com

Now whenever it comes to weight loss you should follow these simple steps that have helped me tremendously lose weight, pretty quickly if you ask me. And Ive been trying to lose weight forever and finally found the correct system to help me out
The first thing you need to do is about 30 minutes of cardio everyday, try to get at least 3-4 days of that peopleExercising is one very important issue you dont want to be lazy in.
The second thing you should realize is that you cannot eat everything in sight that probably got you looking the way you are right now or the reason you want to lose weight. The pounds come with the food you eat. How do you stop yourself from eating and get a little boost with ousting fat from the food you eat? Simple
The third and final step is the correct natural weight loss supplement. For me, I found Proactol to be the best. Now this isnt aimed towards lazy people that want to take a pill and sit on the couch all night and day. These are to tremendously help out with dieting and exercising. For me they were great because with my diet, they basically take out up to 28% of the fat you intake. Not to mention the killer appetite suppressant Proactol is. Every day you will fall under your calorie intake and find yourself one more day closer to your goal.
These steps really worked for me, you should try them out for yourself even if you want to lose very little or that extra mile. Also at the time of my 3 month supply purchase of Proactol, I saved a lot of money on it at theweightlossplace .com
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Farma Universe Advice » Blog Archive » Generic Propecia » Blog Archive

2008-11-24T10:22:31Z

We keep on hearing good news about the finasteride hair loss drug that is made by Merck and goes by the name of Propecia. We have been receiving literally hundreds of emails from men who say that either their hair loss has stopped or in some cases they even regrow some of their hair. We are also aware that there are hundreds of hair loss products on the market out there and most of them come to your attention with glitzy advertising and sophisticated marketing methods.
At Ukmedix we admit that we don’t know if these hair loss products work or not but the fact of the situation is that most of them have not been properly tested and therefore can’t get proper EMEA or FDA approval.
When a serious drug company discovers a drug and wishes to sell and market it they first have to go through an exhaustive procedure that can cost many millions of pounds. There are various stages of testing which usually start with tests to make sure the drugs have no serious side effects. When the relevant drug authorities are satisfied that this is OK the drug company is then given the green light to continue with further testing to check that the drug is safe. The FDA and The EMEA continually monitor these tests and they have to follow various guidelines to make sure the results are fair and not misleading. Only after these extensive tests are drugs like hair loss drugs given full approval.
Propecia can claim to be the most tested and clinically research hair loss drug in the world with literally millions of individual men using it at any one time. Estimates say that around 4 million men are using Propecia in the world today and the number is rising. Propecia is not allowed to be directly marketed to men and has to have a doctor’s prescription and it is only because doctors are aware of the fact that the drug works and that it is safe for people to use it that it has become the No.1 prescribed hair loss medicine for male pattern balding in the world.
The facts speak for themselves and which is why we consider at Ukmedix that Propecia is the No.1 most effective hair loss drug in the world for men with genetic male pattern balding. Watch out for hair loss drugs and supplements that have no proper clinical data. The company that sells the drug can make all sorts of claims and have lots of testimonials from happy customers but it is the clinical data that matters.

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2008-11-24T08:22:21Z

The inspector-general heavily criticized the CIA, concluding that the program it backed in Peru to stop drug-running was so badly managed that many suspect aircraft were shot down without making the proper verifications first.
Such was the case in 2001, when a CIA surveillance plane mistook a plane flying a missionary family for one carrying drugs, and ordered it taken down. Two passengers were killed and the pilot was badly injured.
The inspector-general noted in his report that the CIA tried to say that the tragic mistake was a one-time incident. However, it appears that intercept procedures were routinely ignored.
Those involved in the program told investigators that if proper identification procedures were followed, suspect aircraft would have had time to escape. They also said it was easier to shoot down the aircraft than to force it down. Consequently, suspect aircrafts were shot down within 2-3 minutes of being seen by the fighter plane without being identified or warned to land.
The inspector-general said the CIA had found significant procedural violations in its own internal investigation, but refused to giv congress, the security council, or the justice department access to the results. It even reported that the program was complying with all laws. General council managers ordered that nothing be written down to avoid criminal charges. In addition, inquiries from then security advisor Condoleezza Rice were ignored.
CIA spokesman Gimigliano said that the director had not made any decisions, but that questions of responsibility and accountability are taken seriously.

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2008-11-22T11:21:49Z

A rarely used 30-year-old medicine has proved to be a surprisingly effective treatment for life-threatening congestive heart failure, reducing the death rate by nearly one-third.
Doctors who conducted a large study that was released today recommended that the drug, Aldactone, be immediately added to the other standard medicines given to victims of severe heart failure.
''No one believed that this drug would work this way,'' said Dr. Bertram Pitt of the University of Michigan. ''It surprised the real experts, but they are of course happy that we have something new to help people.''
Dr. Pitt directed the study, which was conducted on 670 people in 15 countries. The study was stopped after two years, and 18 months earlier than planned, because the drug proved to be so beneficial.
The study's results are to be published on Sept. 2 in the New England Journal of Medicine. The journal made the findings public early on its Web site because of their medical importance. The study was financed by G.D. Searle, which makes the drug.
About five million people in the United States have congestive heart failure, which results when a weakened heart cannot pump the blood forcefully enough. Dr. Pitt estimated that one-quarter to one-third should be treated with Aldactone.
''The results are great. The fact that they saw this degree of improvement in patients who were already getting aggressive treatment is very exciting,'' said Dr. Ann Bolger of the University of California at San Francisco, a spokeswoman for the American Heart Association.
Aldactone, known generically as spironolactone, was once routinely used for heart failure and high blood pressure. It works by blocking production of aldosterone, a hormone that among other things increases salt retention, promotes the loss of magnesium and potassium, raises adrenaline levels and makes the blood vessels stiffer.
Over time, Aldactone fell from favor as newer medicines were developed. Among these are ACE inhibitors, a class of drugs that have recently become standard therapy for heart failure. Although ACE inhibitors also block aldosterone, it now appears that they do so poorly. Aldactone protects the heart by stopping even more of the hormone.
Even for patients taking Aldactone, the death rate from severe heart failure is high. After two years of treatment, 35 percent of those getting Aldactone died, compared with 46 percent of people who received standard medicines.
Forty-one percent of patients on Aldactone found that their symptoms had improved, compared with 33 percent in the comparison group.

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2008-11-17T08:32:05Z

by Christine G. Shannon

Have you ever wondered how Hollywood celebrities manage to look stick thin? Which diet do they follow? If you look closely, you can also see that a lot of these celebrities look ill. Starving themselves might give them skinny bodies but it deprives the body of necessary nutrients, leads to tiredness and side effects such as headaches and bad breath and constant hunger pangs are nobodys idea of a good time.

There are always stories of celebrity weight loss in the newspapers and in magazines. Celebrities also come up with fictional diets to explain how they shifted the weight, whereas in reality they just starved themselves, not only of food but of the essential foods and fluids necessary for the body to properly function.

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(CNN) – World leaders rushed to congratulate Democrat Barack Obama on Wednesday following his historic win in the 2008 U.S. presidential election. The following are their statements on the president-elect.

Chinese President Hu Jintao:
The Chinese government and I have always attached great importance to the Sino-U.S. relations. In the new historical period, I look forward to endeavor together with you … to continue to strengthen the dialogue and communication between the two countries, to enhance mutual trust and cooperation, to push the Sino-U.S. constructive cooperation relations to a new level, in order to better benefit the two people and the peoples of the world.
Chinese Prime Minister Wen Jiabao:
The good relationship between China and the United States is the shared hope of people of the two countries, it is also needed in the safeguarding of the peace, stability and prosperity of Asia-Pacific region and the world.
… Through the common endeavor of both countries, the constructive cooperation relationship between China and the United States will definitely acquire new development.
British Prime Minister Gordon Brown:
I would like to offer my sincere congratulations to Barack Obama on winning the presidency of the United States. I would also like to pay tribute to Senator McCain who fought a good campaign and has shown the characteristic dignity that has marked a lifetime of service to his country.
The relationship between the United States and the United Kingdom is vital to our prosperity and security. Barack Obama ran an inspirational campaign, energizing politics with his progressive values and his vision for the future. I know Barack Obama and we share many values. We both have determination to show that government can act to help people fairly through these difficult times facing the global economy. And I look forward to working extremely closely with him in the coming months and years.
Kenyan Prime Minister Raila Odinga:
The significance of this victory will resonate with hundreds of millions of people around the world. It is indeed time for global renewal.
The strong message of hope and a vision of a world united in dealing with global challenges delivered by the president-elect in his campaigns is admirable, timely and welcome. The perseverance and endurance that the president-elect has shown during his campaigns is an inspiration to the world.
The people of Kenya wish the president-elect and the people of America every success in their endeavors in the years to come. There can be no doubt that America is indeed a nation conceived in liberty and dedicated to the proposition that all men are created equal.
German Chancellor Angela Merkel:
My sincere congratulations on your historic victory in the presidential election.
The world faces meaningful challenges at the start of your term in office. Im convinced that through a close and trusting cooperation between the United States and Europe we will be able to confront new risks and challenges in a decisive manner and will be able to take advantage of the numerous opportunities that are opening up in our world. Rest assured that my government appreciates hugely the meaning and value of the trans-Atlantic relationship for our common future.
I remember with pleasure our conversation during your visit to Germany last July and look forward to working together with you in the future.
Iraqi government spokesman Ali al-Dabbagh:
The Iraqi government has a true desire to work and cooperate with the elected president for the best interest of the two countries to spread security and ensure Iraqs full sovereignty in a way that this will guarantee the interest of Iraqi people.
Israeli Prime Minister Ehud Olmert:
Once again, America has proven that it is, indeed, the greatest democracy and constitutes an example for all other democracies in the world. President-elect Obama has proven his leadership and his talents to the entire world.
… The special Israel-U.S. relationship is based on shared values and interests and is characterized by ties of close cooperation. Israel and the United States have a common desire to advance peace and stability in the Middle East. We have no doubt that the special relations that prevail between the two countries will continue to strengthen during the Obama administration.
Israeli President Shimon Peres:
It was an American election and a worldwide choice.
… I want to congratulate the newly-elected president: young, fresh, promising, representing a change and introducing change. The changes that I can mention — it is an opportunity to escape the present world crisis and enter into a new era of cooperation, of productive economy and of human solidarity. In a way, it is an end of racism. There is no longer any way that any white man can claim superiority, nor any black person feel discrimination. We are the same people, and this election is a great statement to that effect.
… I also have the utmost respect for the other candidate, John McCain, who fought with great courage and stamina.
… When President Obama was here, he asked me what he can do for Israel. My answer was: Be a great president of the United States of America. If you will be a great president of the United States of America, you will have great promise for Israel as well, and for all of the region and for all of our neighbors. Nobody should look at whose side the president is on — he just has to be on the side of peace. And if he will be on the side of peace, peace will come closer and more possible.
Palestinian negotiator Saeb Erakat:
Erakat said Palestinian President Mahmoud Abbas congratulates Obama.
We think that America is united behind the two-state solution and we hope that President-elect Obama will continue the engagement immediately and that he will transfer the vision of two states from a vision to a realistic political track, Erakat said.
European Commission President Jose Manuel Barroso:
This is a time for a renewed commitment between Europe and the United States of America.
I want to assure Senator Obama of the support of the European Commission and of my personal support in forging this renewed commitment to face together the many challenges ahead of us.
We need to change the current crisis into a new opportunity. We need a new deal for a new world. I sincerely hope that with the leadership of President Obama, the United States of America will join forces with Europe to
drive this new deal. For the benefit of our societies, for the benefit of the world.
European Union foreign policy chief Javier Solana:
I think like every election, it means renewal. The ticket on which Barack Obama has run, this ticket for change — change is what we need in the world today. Many problems we have on the table, and I very much hope that well be able to do it together — to find a solution to them together, between the European Union and the United States.
… I would also like to say that it will not be enough to have the European Union and the United States together. The problems of today well need also to incorporate other main players. I think about China, I think about the organization like the African Union and many others.
Therefore, we have a very important day, a historical day and hope very much that the Europeans will be together also to make the utmost of this important moment.
Indian Prime Minister Manmohan Singh:
I have great pleasure in conveying my heartiest congratulations on your election as the president of the United States. Your extraordinary journey to the White House will inspire people not only in your country but also around the world.
The people of India and the United States are bound by their shared commitment to freedom, justice, pluralism, individual rights and democracy. These ideals provide a solid bedrock for friendship and strategic partnership between our two nations. We have strong ties between our peoples and I look forward to working with you to realize the enormous potential for cooperation that exists between India and the United States. Our two countries working together to address global issues and challenges will be an important factor for world peace, stability and progress.
Former South African President Nelson Mandela:
Your victory has demonstrated that no person anywhere in the world should not dare to dream of wanting to change the world for a better place.
We note and applaud your commitment to supporting the cause of peace and security around the world. We trust that you will also make it the mission of your presidency to combat the scourge of poverty and disease everywhere.
We wish you strength and fortitude in the challenging days and years that lie ahead. We are sure you will ultimately achieve your dream making the United States of America a full partner in a community of nations committed to peace and prosperity for all.
Archbishop Desmond Tutu:
s an epoch-making event filling the whole world with hope that change is possible. It is just tremendous; it is saying to people of color that for them, the sky is the limit.
My heartiest congratulations go to Senator Barack Obama and his partner Senator Joe Biden on their victory.
I also want to congratulate Senator John McCain for his gracious references to Senator Obama in his conceding speech.
We have a new spring in our walk and our shoulders are straighter. It is almost as when Nelson Mandela became president of South Africa in 1994.
French President Nicolas Sarkozy:
In choosing you, its the choice for change, the opening up and the optimism of the American people. While the world is in turmoil and doubt, the American people, loyal to their values that have always been the American identity, forcefully expressed their faith in progress and the future.
This message from the American people resonates well beyond your borders. In the moment where we must face together immense challenges, your election raises immense hope in France, in Europe, and beyond, throughout the world. This open America, united and strong, will show the way anew, with its partners, by the strength of its example and its adherence to its principles.
France and Europe, which have always been connected to the United States by ties of history, values, and friendship, will draw a new energy from this to work with America at preserving world peace and stability.s Deputy Parliament Speaker Mohammad Hossein Abutorabifard:
Obama can change the defeated Bush policies and in so doing can play an important role in the future relations between the U.S. and Asia and the Middle East.
… If the United States takes into consideration the realities of the world and chooses suitable policies, America can play its (proper) role in the relations between the United States and the countries of the region and theworld of Islam.… It seems that this election has prepared the ground for a revision in the Democrats and Obamas future policies of the United States.
Spanish Prime Minister Jose Luis Rodriguez Zapatero:
Zapatero congratulated Obama for his extraordinary election victory and said it opens the road of hope for the world in times of difficulty.
In a telegram sent to Obama, Zapatero wrote, As prime minister of the government of Spain, I let you know of our desire to work together to search for opportunities and solutions to tackle the challenges we face.
I am convinced, as you are, that dialogue and collaboration with governments and multilateral institutions is the best way to find the answers that we need.
Zimbabwe opposition party Movement for Democratic Change:
s victory is a victory of hope, faith, change, a restart, values and dreams which have underpinned our fight as a movement against dictatorship and the neo-fascism of Robert Mugabe.
s victory will hopefully usher in a departure from the politics of polarization, fear, unilateralism and arrogance that has defined the Bush doctrine in the last eight years. Indeed, we hope that Obama will open new avenues of dialogue of new interaction based on respect of all countries irrespective of the size of national budgets or the number of fighter jets owned.
… We are mindful of the difficulties that lie ahead in Obamas path and the fact that this is no El Dorado, a construct that Obama himself acknowledges in his acceptance speech. Indeed it is a task that may take more than his two terms of office. Perhaps the greatest thing we have learnt from this victory is that democracy can work and that there is no alternative to the same.
John McCains speech was particularly humbling, instructive and inspiring. If in Africa, incumbents would accept defeat and would graciously depart from the seat of power, this would be a different continent, and indeed Zimbabwe would be a different place.
For those of us who are still in the trenches, fighting for change and democracy across the entire African continent, this is our victory. One which for now we will savor and celebrate.

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Newswise The 20th annual conference of The MacLean Center for Clinical Medical Ethics at the University of Chicago will honor the Centers founder and director, Mark Siegler, MD, and examine his work and influence on the field. The conference will be held at the University of Chicago Law School, 1111 E. 60th Street, on Fri., Nov 14 from 1 to 5 pm, and Sat., Nov. 15, from 7:30 am to 5:15 pm.
The conference will be a a European tradition in which a scholars colleagues and trainees honor him with a discussion of the his work.
The conference is organized around 16 of Sielgers elegant and opinionated writings on the doctor-patient relationship, the development of the field of clinical medical ethics, improved end-of-life care for patients, and new ethical approaches to innovations in surgical can cancer care.
The Lindy Bergman Distinguished Service Professor of Medicine at the University, Siegler has written and spoken extensively on decision-making in complex medical situations, such as intensive care, end-of-life decision making and living-donor organ transplantation. These stressful situations serve as clinical probes, he said. They can help us understand the process by which patients and doctors reach everyday decisions.
Siegler founded The MacLean Center in 1984. It quickly became the country’s leading center for teaching clinicians about patient-centered medical ethics. Since 1984, nearly 250 fellows—most of them physicians, but also nurses, legal scholars, theologians, and philosophers—have trained at the Center in a one- or two-year fellowship program.
Former MacLean fellows, many of who will speak at the conference, have published more than 60 books in the field. More than 30 have directed ethics programs in hospitals and research centers in the United States, Canada and Europe. More than 25 are now full professors at leading academic institutions and about a dozen hold endowed university professorships.
Although there is no fee for this conference, the organizers ask that attendees register online at http://ethics.bsd.uchicago.edu/events/2008conference.
CONFERENCE SCHEDULE
DAY ONE: Friday, November 14, 2008
The MacLean Center and its Role in the Development of Clinical Ethics
1:00 pm Opening Remarks and Welcome
Lainie Ross and Mary Ann MacLean
1:10-1:45 pm The MacLean Center Then and Now
THEN: Al Tarlov, Ann Dudley Goldblatt and Joel Howell*
NOW: Skip Garcia, Jim Madara and Lainie Ross
1:45-2:45 pm Clinical Ethics: The Field Then and Now
THEN: Ed Pellegrino, Paper #1: “Clinical Medical Ethics.” 1990.
NOW: Peter Singer*, Paper #2: “Clinical Ethics Revisited.”
3:00-4:30 pm Shared Decision Making and the Doctor-Patient Relationship
Paper #3: “The Nature and Limits of Clinical Medicine” 1979.
Paper #4: “Searching for Moral Certainty in Medicine: A Proposal for a New Model of the Doctor-Patient Encounter.” 1981.
Speakers: Bob Levine, Jack Wennberg, Peter Ubel*
4:30-5:30 pm Futility and Hope
Paper #5: “Pascal’s Wager and the Hanging of Crepe.” 1975
Paper #6: “The Illusion of Futility in Clinical Practice.” 1989.
Paper #7: “The Rise and Fall of the Futility Movement.” 2000.
Speakers: William May, John Lantos* Caleb Alexander
DAY TWO: Saturday, November 15, 2008 Clinical Medical Ethics Chair: John Lantos*
Morning Session: The Impact of Clinical Ethics on Patient Care
8:30-9:15 am The MacLean Center as Part of the University of Chicago
Speakers: Arthur Rubenstein (Medicine) Richard Epstein (Law) Ed Laumann (Sociology) Ed Lawlor (The Harris School and SSA)
9:15-10:15 am Clinical Ethics and Patient Care
Paper #8: “The Contributions of Clinical Ethics to Patient Care.” 1997.
Paper #9: “Confidentiality in Medicine — A Decrepit Concept.” 1982.
Speakers: Jim Childress, Daniel Sulmasy
10:45-12 pm Clinical Ethics Consultation and End of Life Care
Paper #10: “An Ethics Consultation Service in a Teaching Hospital: Utilization and Evaluation.” 1988.
Paper #11: “A Medicine of Strangers or a Medicine of Intimates: The Two Legacies of Karen Ann Quinlan.” 1992.
Speakers: Susan Tolle* Paul Helft* Woody Moss* Annette Dula*
Afternoon Session: The Three Pillars of Academic Medicine: Research, Teaching and Patient Care
1:30-2:45 pm Clinical Ethics Research and Research Ethics Consultation
Paper #12: “Perceptions of Cancer Patients and Their Physicians Involved in Phase I Trials.” 1995
Paper #13: “Learning from Our Patients: One Participant’s Impact on Clinical Trial Research and Informed Consent.” 1997.
Speakers: Al Jonsen, Carol Stocking, Rick Kodish* Chris Daugherty*
2:45-3:30 pm Teaching Ethics
Paper #14: “A Legacy of Osler: Teaching Clinical Ethics at the Bedside.” 1978.
Speakers: Jordan Cohen, Laura Roberts*
3:45-5 pm Ethical Issues in Surgery and Organ Transplantation
Paper #15: “Identifying the Ethical Aspects of Clinical Practice.” 1996.
Paper #16: “Ethics of Liver Transplantation with Living Donors.” 1989.
Speakers: C. Rollins Hanlon, Peter Angelos* Ira Kodner* Charles Bosk
5-5:15pm Looking Back, Looking Ahead Mark Siegler
* Speaker is a former MacLean Center Ethics Fellow.

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Kumquat Connection: Week 11: Butternut Mash Pernicious Boys

2008-11-06T05:21:04Z

In creating the recipe I am sharing with you, I use the Butternut Squash Risotto from Chez Panisse Vegetables as a jumping off point. Some changes Ive made to that recipe include roasting the squash beforehand, substituting vegetable stock for chicken stock, lowering the amount of broth (I like a stickier risotto and the Chez Panisse recipe creates a brothy, soupy risotto), and of course I also substitute an ambercup squash for their butternut. Risotto has a stigma for being time consuming, and when you mention cooking it, people envision you standing over the stove obsessively pouring in spoonfuls of broth every 2 minutes, amidst continuous stirring of the rice. Mom and I discussed this perception, and we arent really sure where it comes from. I do stir the rice for a second after adding additional broth, but I promise that this risotto is incredibly simple, easy, and you wont have an arm cramp when it is time to eat. Get ready to savor the delicious textures of fall in this dish--this is cozy, healthy, comfort food at its best. I end up craving this dish again maybe two hours after we finish the leftovers.
One last quick note about risotto: if you have a dutch oven-type pot, use that. If you dont, your largest soup pot will suffice.
Separately, thank you so much for the gorgeous gift for my birthday! You are so sweet, and I cannot wait to get to know the cookbook better--and to try out the recipes! Of course, due to your hint that your winter squash recipe is related to the book, I am so intrigued to learn what youve made for this week.
Thanks again, you are the best.
xo,
Leigh

Roasted Ambercup Squash Sage Risotto

1 medium ambercup squash (about 2 pounds whole or your sweet winter squash of choice
24 sage leaves
Salt and pepper
6 to 7 cups vegetable stock
1 medium onion
5 1/2 tablespoons unsalted butter*
2 cups Arborio rice
1/2 cup white wine
1/2 cup Parmigiano Reggiano, grated*

1. Preheat the oven to 400. Peel and clean the squash, then dice it into approximately 2-inch cubes. Put the diced squash in a Pyrex-type 9x13 dish, splash some olive oil on top of the cubes, add salt and pepper. Place pan in the oven and let cook for approximately 30 minutes--stirring the cubes every 10 minutes.
2. While the squash is roasting, combine a few chopped sage leaves and the stock in a saucepan. Bring to a low simmer, and hold it there.
3. Chop 6 sage leaves fine and dice the onion.
4. In a heavy-bottomed saucepan, heat 3 tablespoons of butter, add the chopped sage and cook for a minute or so; add the onion and continue to cook over medium heat until translucent, about 5 minutes. Add the rice and cook over low heat for about 4 minutes, stirring often, until the rice has turned slightly translucent. Turn up the heat and pour in the white wine. When the wine has been absorbed, add just enough hot stock to cover the rice, stir well and reduce the heat.
5. Keep the rice at a gently simmer and continue to add more stock, a ladle or two at a time, letting each addition be absorbed by the rice.
6. After 15 minutes, the rice will be nearly cooked. Stir in the cooked squash, the rest of the butter and the cheese. Continue cooking for 3 to 5 minutes, stirring often. Taste for texture and consistency, adding more stock if necessary. Adjust the seasoning.

*To make a delicious vegan version of this recipe, as I have many times, substitute the butter for Earth Balance, and the parmesan cheese for 1/2-3/4 cups nutritional yeast.

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Asian Conciliatory Poker Tour heads to Manila

2008-11-05T09:30:56Z

Last weekend was the fourth annual "Mike's Birthday Family Poker Invitational Fiasco" where I futilely attempt to get my non poker playing relatives to learn how to play poker. As much as I complain about them not getting it, I think some of them may actually be starting to pick up on a few things. I think we even made it through the event without the traditional infinite check loop that they tend to get stuck in.

Lets go around the table and I'll introduce you to this year's players.

To my left we my wife's Aunt Karalee. She claims to have played a lot poker back in the day, and knows more or less what she is doing, but is quite rusty. She has issues with the whole betting "before you get to see all your cards and know exactly what you have" thing. Then again, I don't think I got anyone to raise pre-flop.

(note to self: Next year I need to stress raising rather than calling, and the benefits of limiting the field in a hand where you are favored.)

Left of Karalee was Uncle Jim who isn't a terrible player. He actually won last year or the year before. He is a little tentative in his play, but he did actually raise on occasion which puts him light years ahead of the rest of the table.

After Jim is my father in law and my wife's Aunt Char. I think the only reason they play is because I'm organizing it, and have very little intention to actually play or strategize. I think they are lost causes.

My wife is after them, and I'm proud to say that she is a pretty good player for someone who only plays once a year. I've forced to watch enough poker on TV where she understands strategy, and when to bet or raise or fold. She's probably better than half the people at our regular monthly games. I should also note that she started talking trash about a week before the event claiming that she was going to win and that she had a new strategy. That new strategy was to use the handranking cheatsheet that I provided for everyone.

My parents rounded out the table. They don't particularly care for the poker, but play just to humor me. They do however at least try to play well, and figure out what they are doing. My Dad is also one of the few players to actually use a raise. He's a maniac!

So on to the game. I tried to explain to everyone the value of good hand selection before we started, but I don't think may people paid attention since the average number of players seeing the flop at our eight handed table was 6.

I can't recall as many comical plays as in previous years. I'm not sure if its because they are actually getting better, or if I was doing a better job of moving the game along, or if I just don't find it humerus anymore.

A couple hand of note, which I feel bad about. I crippled my dad when I played ATs for a raise. He called and the flop was ragged, but with two of my suit. The turn was a king and one of the other fifteen people in the hand made a small bet, which he min raised. A bigger bet and I probably would have folded, but I didn't and rivered a flush to beat his AK. Of coarse on the river I made a big raise which he called.

I feel bad because he played a good hand, raised when he made top pair, and still lost. On the other hand, he should have raised preflop like I had instructed and bet more when he made his hand, so hopefully he will learn that for next year. I'm guessing not though.

The other hand was against my wife. I had wired nines and she had AQ. The flop was AQ9 and I took all of her chips, putting me in the chip lead for good. Not much she could do there. She flopped top two pair, and even though I raised her bets, and bet bet big when she checked, its hard to think your hand isn't good in that situation. Unless you've played a lot, and even then its tough to put me on trips rather than AK.

On the positive side, after I raised her bet on the flop, she was about to bet on the turn, and Karalee pointed out that she should check because she knows I'm going to bet anyway. So at least someone is paying attention.

The final three were myself Aunt Karalee and Uncle Jim. I had a huge chip lead and they stood no chance since they weren't willing to bet without a hand and the blinds were a significant portion of their chipstack.

I kept bluffing whenever they would check, and then showing my hand and pointing out that if they check it doesn't matter what I have, if I bet I've got a good chance of winning the pot. No one ever picked up on it though and even after it checks around on the flop and turn, they'd rather check around again on the river than try to steal the pot.

(note to self: Next year do a better job of explaining how to take advantage of position.)

So that was it. After that we got everyone to play wii games. Watching non-video-game playing relatives play Rayman Raving Rabbids is pretty funny. I'd recommend you try that.

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